RESUMO
BACKGROUND: Although patients with head and neck squamous cell cancer (HNSCC) often show malnutrition, its effects on immune checkpoint inhibitor (ICI) treatment outcomes in these patients are unclear. OBJECTIVES: To investigate the prognostic influence of nutritional indices in patients with HNSCC treated with ICIs and determine the optimal indices. METHODS: This retrospective study included 106 patients with HNSCC treated with ICIs between 2017 and 2022. The prognostic influences of body mass index (BMI), geriatric nutritional risk index (GNRI), and prognostic nutritional index (PNI) on overall survival (OS) and progression-free survival (PFS) were analysed using the Kaplan-Meier method and Cox-regression models. RESULTS: The 1-year PFS rates in the groups with high and low BMI, GNRI, and PNI were, respectively, 24.2% and 28.4% (p = .731), 29.7% and 14.4% (p = .024), and 30.3% and 13.9% (p = .015). PNI was an independent prognostic factor for both PFS (hazard ratio (HR) = 1.89; 95% confidence interval (CI), 1.08-3.29) and OS (HR = 3.26; 95% CI, 1.66-6.40). CONCLUSIONS: PNI can predict ICI outcomes and should be assessed when ICI treatment is considered.
Assuntos
Neoplasias de Cabeça e Pescoço , Avaliação Nutricional , Humanos , Idoso , Prognóstico , Inibidores de Checkpoint Imunológico/uso terapêutico , Carcinoma de Células Escamosas de Cabeça e Pescoço/tratamento farmacológico , Estudos Retrospectivos , Neoplasias de Cabeça e Pescoço/complicações , Neoplasias de Cabeça e Pescoço/tratamento farmacológicoRESUMO
Purpose: To evaluate the feasibility and safety of transarterial injection of a miriplatin-iodized oil suspension combined with Emprint miriplatin-iodized oil suspension-microwave ablation in patients with medium-sized (3-5 cm) hepatocellular carcinomas. Materials and Methods: This retrospective study included a total of 11 patients with 12 hepatocellular carcinomas (mean size, 3.6 ± 0.6 cm) underwent miriplatin-iodized oil suspension-microwave ablation. Microwave ablation was performed under the guidance of computed tomography fluoroscopy following transarterial miriplatin-iodized oil suspension injection on the same day. Technical success, complications, and local tumor progression were assessed. Results: The primary and secondary technical success rates were 75.0% and 100%, respectively. The number of treatment sessions per nodule was 1.25 ± 0.45. A total 15 sessions were required to achieve technical success (one session in nine lesions, two sessions in three lesions). Two major complications (pneumothorax [n = 1] and hemorrhage [n = 1]) occurred (2/15, 13.3%). No local tumor progression was observed during the follow-up period (mean 12.0 ± 2.0 months, range 2.7-23.9 months). Conclusions: Miriplatin-iodized oil suspension-microwave ablation for medium-sized hepatocellular carcinomas can be safely performed with good local control.
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OBJECTIVE: Radioactive iodine (RAI) therapy is a useful treatment for Graves' disease (GD). Most RAI sessions administer ≤ 500 MBq of iodine (I)-131. Sometimes patients require repeated RAI, often for longer periods of remission. We investigated the characteristics of patients for whom high dose (mostly 1110 MBq of I-131) RAI was effective as RAI therapy for GD. METHODS: We retrospectively analyzed the cases of 79 patients who underwent RAI for GD in a multicenter setting. We divided the patients into two groups based on the I-131 dose administered: the low dose (LD) group who received ≤ 500 MBq (n = 44) and the high dose (HD) group who received > 500 MBq (n = 35). The therapeutic effect was defined as achieving remission and reaching the point of participating in thyroid hormone replacement therapy within 1 year after RAI. We compared the LD and HD groups' remission rates and conducted a multivariate logistic regression analysis of predictive factors for remission. In a simulation, using the formula for predicting the probability of remission obtained from the analysis results, we estimated how much the remission rate would change if the I-131 dose is increased from 500 to 1110 MBq. RESULTS: The mean ± standard deviation I-131 dose administered in the LD group was 480 ± 6 MBq, and that of the HD group was 1054 ± 265 MBq. Thirty-five patients (80%) in the LD group and 26 patients (74%) in the HD group achieved remission; this difference in the remission rate was not significant. The multivariate analysis results demonstrated that the absorbed dose and thyroid-stimulating antibody (TSAb) were independent predictors of remission. Seven patients (8.9%) showed an increased probability of remission from < 50% to > 50% when the higher RAI dose was applied (1110 MBq instead of 500 MBq). The thyroid volume and TSAb values in these patients were relatively large at 54.7 ± 34.2 mL and 1378.4 ± 586.3%, respectively. CONCLUSION: Although the overall remission rate was not significantly different between the patients who received high- or low-dose I-131, treatment with high-dose RAI may improve the probability of remission in patients with a massive thyroid volume and/or high-TSAb Graves' disease.
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Doença de Graves , Iodo , Neoplasias da Glândula Tireoide , Humanos , Radioisótopos do Iodo/uso terapêutico , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/tratamento farmacológico , Resultado do Tratamento , Doença de Graves/radioterapiaRESUMO
PURPOSE: To compare the technical efficacy and complications of the transarterial injection of a miriplatin-iodized oil suspension combined with radiofrequency ablation (RFA) or microwave ablation (MWA) in the treatment of small hepatocellular carcinomas (HCCs). MATERIALS AND METHODS: This retrospective study included 123 HCCs in 101 patients treated with the transarterial injection of a miriplatin-iodized oil suspension and RFA (MPT-RFA) (maximum diameter: 1.5 [Formula: see text] 0.5 cm, range: 0.6-3.0 cm) and 68 HCCs in 49 patients treated with the transarterial injection of a miriplatin-iodized oil suspension and MWA (MPT-MWA) (maximum diameter: 1.6 [Formula: see text] 0.7 cm, range: 0.5-3.0 cm). Technical success was defined as the achievement of an ablative margin of at least 5 mm for each tumor. Technical success, complications, and local tumor progression were compared between the two groups. RESULTS: The initial technical success rate was significantly higher with MPT-MWA (94.1%) than with MPT-RFA (76.4%; P = 0.003). The number of treatment sessions per nodule was significantly lower with MPT-MWA (1.1) than with MPT-RFA (1.3) (P = 0.004). The major complication rates were similar with MPT-RFA (5.8%) and MPT-MWA (2.7%) (P = 0.391). The one-year local tumor progression rate was similar between MPT-RFA (0%) and MPT-MWA (0%) (P = 0.73). CONCLUSION: MPT-MWA may have improved therapeutic efficiency in the treatment of small HCCs.
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Carcinoma Hepatocelular/terapia , Ablação por Cateter/métodos , Meios de Contraste/administração & dosagem , Óleo Iodado/administração & dosagem , Neoplasias Hepáticas/terapia , Micro-Ondas/uso terapêutico , Compostos Organoplatínicos/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
A 69-year-old man was hospitalized urgently to the department of cardiology, with the progressive general malaise. On admission, his blood pressure was 80/42 mmHg, his white cell count 13,700/µl, and C-reactive protein 25.55 mg/dl suggesting existence of aggressive infection with impaired circulation. Massive pericardial effusion was detected in echocardiography. Pericardial drainage was undergone promptly. There was drainage of 700 ml and the property was purulent. Pneumococcus was detected by the culture test of the pericardial fluid. Antibiotic administration was started by a diagnosis of the purulent pericarditis. His general condition was improved. However, a rapidly expanding saccular aneurysm was found in a descending thoracic aorta by computed tomography( CT). As an infected thoracic aortic aneurysm secondary to the purulent pericarditis, we performed thoracic endovascular aneurysm repair (TEVAR). The intravenous administration of antibiotics was continued for 2 weeks after TEVAR, which was followed by oral antibiotic administration for 1 year. The aneurysm completely disappeared by CT, 10 months after TEVAR. In case with an infected thoracic aortic aneurysm, TEVAR can be a 1st choice of treatment, depending on a causative organism and the morphology of the aneurysm.
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Aneurisma Infectado/etiologia , Aneurisma da Aorta Torácica/etiologia , Derrame Pericárdico/terapia , Pericardite/complicações , Idoso , Aneurisma Infectado/microbiologia , Aneurisma Infectado/terapia , Antibacterianos/uso terapêutico , Aorta Torácica , Aneurisma da Aorta Torácica/microbiologia , Aneurisma da Aorta Torácica/terapia , Proteína C-Reativa/análise , Drenagem/métodos , Humanos , Contagem de Leucócitos , Masculino , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/microbiologia , Pericardite/microbiologia , Streptococcus pneumoniae/isolamento & purificação , Supuração/microbiologia , Supuração/terapia , Resultado do TratamentoRESUMO
BACKGROUND: Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) is an ideal procedure in selected patients with benign or low-grade malignant tumors in the body/tail of the pancreas. We describe our procedure and experience with splenic vessel-preserving LSPDP (SVP-LSPDP) in a retrospective case series. METHODS: Six consecutive patients underwent SVP-LSPDP from January 2011 to September 2013. We evaluated the courses of the splenic artery by preoperative computed tomography and applied an individualized approach (the superior approach or inferior approach) to the splenic artery. RESULTS: All of the operations were successful. The median surgical duration was 249 minutes. The median blood loss was 0 mL. Pathologic examination revealed 4 cases of insulinoma, 1 case of solid pseudopapillary tumor, and 1 case of pancreatic metastasis from renal carcinoma. CONCLUSIONS: In performing SVP-LSPDP, it is effective to make a strategic choice between 2 different approaches according to the course of splenic artery.
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Perda Sanguínea Cirúrgica/prevenção & controle , Laparoscopia/métodos , Pancreatectomia/métodos , Neoplasias Pancreáticas/cirurgia , Baço/irrigação sanguínea , Artéria Esplênica/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Baço/cirurgia , Resultado do TratamentoRESUMO
AIM: Differentiating intrahepatic cholangiocarcinoma (ICC) from poorly differentiated hepatocellular carcinoma (p-HCC) is often difficult, but it is important for providing appropriate treatments. The purpose of this study was to examine the features differentiating ICC from p-HCC on contrast-enhanced dynamic-computed tomography (CT). METHODS: This study examined 42 patients with pathologically confirmed ICC (n = 19) or p-HCC (n = 23) for which contrast-enhanced dynamic CT data were available. CT images were analyzed for enhancement patterns during the arterial phase, washout pattern, delayed enhancement, satellite nodules, capsular retraction, lesion shape, and presence of an intratumoral hepatic artery, intratumoral hepatic vein, intratumoral portal vein, and bile duct dilation around the tumor, portal vein tumor thrombus, lobar atrophy, or lymphadenopathy. RESULTS: Univariate analysis revealed the presence of rim enhancement (p = 0.037), lobulated shape (p = 0.004), intratumoral artery (p < 0.001), and bile duct dilation (p = 0.006) as parameters significantly favoring ICC, while a washout pattern significantly favored p-HCC (p < 0.001). Multivariate analysis revealed intratumoral artery as a significant, independent variable predictive of ICC (p = 0.037), and 15 ICCs (78.9%) showed this feature. Washout pattern was a significant, independent variable favoring p-HCC (p = 0.049), with 15 p-HCCs (65.2%) showing this feature. CONCLUSION: The presence of an intratumoral artery in the arterial phase on contrast-enhanced dynamic CT was a predictable finding for ICC, and the presence of a washout pattern was a predictable finding for p-HCC, differentiating between ICC and p-HCC.
Assuntos
Neoplasias dos Ductos Biliares/diagnóstico por imagem , Carcinoma Hepatocelular/diagnóstico por imagem , Colangiocarcinoma/diagnóstico por imagem , Meios de Contraste , Neoplasias Hepáticas/diagnóstico por imagem , Intensificação de Imagem Radiográfica , Tomografia Computadorizada por Raios X , Adulto , Idoso , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Artéria Hepática , Humanos , Fígado/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Veia Porta/diagnóstico por imagem , Reprodutibilidade dos TestesRESUMO
PURPOSE: To determine whether the preoperative pancreatic apparent diffusion coefficient (ADC) can be used to predict the development of postoperative pancreatic anastomotic failure (PAF). MATERIALS AND METHODS: We retrospectively examined the cases of 79 patients who underwent pancreatic head resection between January 2010 and October 2013. The patients underwent 1.5-T MR imaging including diffusion-weighted imaging before surgery. The main pancreatic duct diameter (MPD), the pancreatic parenchymal thickness (PT), and the ADC of the pancreatic remnant parenchyma were measured. Two radiologists blinded to the patients' outcomes performed the measurements. The imaging parameters were compared between the patients who developed PAF and those who did not. The cut-off ADC for the development of PAF was calculated with a receiver operating characteristic analysis. RESULTS: The imaging parameters were highly correlated between the two observers. The MPD and PT did not differ significantly among the patients. The mean pancreatic ADCs were significantly higher in the patients with PAF than in those without PAF. An ADC higher than 1.50 × 10(-3) mm(2)/s (Az = 0.719, observer-1) or 1.35 × 10(-3) mm(2)/s (Az = 0.752, observer-2) was optimal for predicting the development of postoperative PAF. CONCLUSION: Measuring the preoperative non-tumorous pancreatic ADC may be useful for the prediction of a postoperative PAF.
Assuntos
Imagem de Difusão por Ressonância Magnética , Pâncreas/patologia , Pâncreas/cirurgia , Pancreatopatias/cirurgia , Complicações Pós-Operatórias/diagnóstico , Cuidados Pré-Operatórios , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Pancreatectomia , Complicações Pós-Operatórias/patologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
BACKGROUND.: The purpose of this study was to assess the usefulness of contrast-enhanced sonography (CEUS) with Sonazoid to demonstrate local recurrence of hepatocellular carcinoma previously treated with radiofrequency ablation (RFA) and not seen on conventional sonography, prior to repeat RFA. METHODS.: This study included 16 cirrhotic patients with 17 cases of hypervascular locally recurrent hepatocellular carcinoma found by contrast-enhanced multidetector row CT (MDCT) but not seen on noncontrast sonography. We used Kupffer-phase imaging and vascular-phase imaging after re-injection. The morphologic patterns of local recurrence detected on CEUS were compared with those on MDCT. We performed repeat RFA guided by CEUS using Kupffer-phase imaging after re-injection. RESULTS.: We were able to detect on CEUS the location of all local recurrences with positive enhancement after re-injection. The morphologic patterns of local recurrence on CEUS were in concordance with those found on MDCT in all lesions. Repeat percutaneous RFA was successfully performed in all lesions. CONCLUSIONS.: The CEUS appearance of local recurrences correlated well with those on MDCT. A wider use of CEUS to guide repeat of percutaneous RFA may be possible with Sonazoid.
Assuntos
Carcinoma Hepatocelular/cirurgia , Ablação por Cateter/métodos , Compostos Férricos , Aumento da Imagem/métodos , Ferro , Neoplasias Hepáticas/cirurgia , Fígado/diagnóstico por imagem , Recidiva Local de Neoplasia/cirurgia , Óxidos , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/diagnóstico por imagem , Meios de Contraste , Feminino , Seguimentos , Humanos , Processamento de Imagem Assistida por Computador/métodos , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Resultado do Tratamento , UltrassonografiaRESUMO
PURPOSE: The purpose of this study was to assess the usefulness of contrast harmonic sonography with a newly developed sonographic contrast agent as a means of guidance for percutaneous radiofrequency (RF) ablation of hepatocellular carcinoma (HCC). MATERIALS AND METHODS: A total of 52 consecutive HCC lesions in 42 patients with HCC who underwent percutaneous RF ablation were included in this study. Altogether, 40 lesions in 35 patients were untreated HCC, and 12 lesions in 7 patients were local tumor progression of an HCC that had already been treated by other methods. We investigated tumors by Kupffer-phase imaging and vascular-phase imaging after reinjection. We performed RF ablation guided by Sonazoid-enhanced sonography using Kupffer-phase imaging and vascular-phase imaging after reinjection. RESULTS: Conventional sonography identified 30 (57%) of 52 HCCs, whereas Sonazoid-enhanced sonography detected 50 (96%) of 52 HCCs (P < 0.01, McNemar's chi2 test). Complete ablation was achieved at a single session in 48 of 50 tumors. CONCLUSION: Sonazoid-enhanced sonography is a useful technique for guiding RF ablation of HCCs, even when treating local progression of a previously treated HCC.
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Carcinoma Hepatocelular/cirurgia , Ablação por Cateter/métodos , Meios de Contraste/administração & dosagem , Compostos Férricos/administração & dosagem , Aumento da Imagem/métodos , Ferro/administração & dosagem , Neoplasias Hepáticas/cirurgia , Óxidos/administração & dosagem , Ultrassonografia de Intervenção/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/diagnóstico por imagem , Distribuição de Qui-Quadrado , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
PURPOSE: The aim of our study was to evaluate the usefulness of percutaneous radiofrequency ablation (RFA) using CO2 microbubbles-enhanced sonography for patients with local tumor progression of hepatocellular carcinoma (HCC). MATERIALS AND METHODS: The tumors of 14 patients with local progression of HCC were treated with CO2 microbubbles-enhanced RFA ablation via a catheter that had been placed in the hepatic artery. We assessed tumor detectability and technical effectiveness. The mean follow-up period was 14.1 months. RESULTS: Only 6 of the tumors could be found on conventional sonography, whereas 14 tumors were detected on CO2 microbubbles-enhanced sonography. These 14 lesions were successfully treated with RFA guided by CO2 microbubbles-guided sonography. Technical effectiveness was complete in all patients. No serious complications were observed, and there was no local tumor progression during the follow-up period. CONCLUSION: RFA guided by CO2 microbubbles-guided sonography is a feasible technique for treating local progression of HCC lesions that cannot be adequately depicted by conventional sonography.
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Dióxido de Carbono , Carcinoma Hepatocelular/cirurgia , Ablação por Cateter/métodos , Aumento da Imagem/métodos , Neoplasias Hepáticas/cirurgia , Microbolhas , Ultrassonografia de Intervenção/métodos , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste/administração & dosagem , Progressão da Doença , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Fígado/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
We report here a case of primary hepatic carcinoid tumor (PHCT) recurring in the remnant liver 13 yr and 10 mo after first resection. A 70-yr-old man developed four hypervascular tumors in the liver in December 2003. He had undergone curative left-lobe hepatectomy for PHCT in February 1990. Histopathological examination of the tumor biopsy specimen showed that the tumor was composed of uniform round-to-oval cells with solid arrangement and the tumor cells stained positive for chromogranin A, synaptophysin, and neuron-specific enolase. We diagnosed this case as an intrahepatic metastasis of PHCT with a long latency period, based on the fact that no primary site of carcinoid tumor could be found despite intensive examination and the immunohistochemical findings of the resected tumors were essentially same as those of PHCT in 1990. Although PHCT is reported to have a more favorable prognosis than other hepatic cancer or metastatic carcinoid tumor in the liver, long-term observation is recommended.
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Tumor Carcinoide/patologia , Tumor Carcinoide/cirurgia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Idoso , Hepatectomia , Humanos , Imuno-Histoquímica , Masculino , Fatores de TempoRESUMO
PURPOSE: Our aim was to evaluate coronal enhancement of hypervascular hepatocellular carcinomas (HCCs) on four-phase CT hepatic arteriography (CTHA). MATERIALS AND METHODS: This study included a total of 86 hypervascular HCCs. Four-phase CTHA images were acquired at 10 sec, 35 sec, 60 sec, and 85 sec after the initiation of contrast medium injection. The rate of coronal enhancement on each phase of CTHA of HCCs was analyzed. The rate of coronal enhancement on each phase of CTHA of HCC was also compared with nodule size. RESULTS: All HCCs showed tumor enhancement on phase-one CTHA. The appearance rates of coronal enhancement on phases-two, -three, and -four CTHA were 87.2%, 67.4%, and 53.4%, respectively. The appearance rates of coronal enhancement of small HCCs on phases-two, -three, and -four CTHA were 91.1%, 53.6%, and 30.5%, respectively; those of non-small HCCs were 80.0%, 93.3%, and 96.7%, respectively. On phase-two CTHA, the presence of coronal enhancement was higher in small HCCs than in non-small HCCs. On phases-three and -four CTHA, the presence of coronal enhancement was significantly higher in non-small HCCs than in small HCCs. CONCLUSION: The optimal phase for achieving coronal enhancement depended on tumor size.
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Angiografia/métodos , Carcinoma Hepatocelular/diagnóstico por imagem , Artéria Hepática/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Neovascularização Patológica/diagnóstico por imagem , Intensificação de Imagem Radiográfica/métodos , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/irrigação sanguínea , Carcinoma Hepatocelular/complicações , Feminino , Humanos , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/complicações , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Neovascularização Patológica/complicações , Prognóstico , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Estatística como AssuntoRESUMO
We report the case of a patient with pancreatic head cancer, whose replaced common hepatic artery (RCHA) arose from the superior mesenteric artery (SMA). We performed preoperative embolization of the RCHA, after which the liver blood flow was well maintained by the left gastric artery. The patient underwent a radical operation involving en bloc resection of the RCHA without any serious complications.
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Embolização Terapêutica , Artéria Hepática/anormalidades , Artéria Hepática/cirurgia , Fígado/irrigação sanguínea , Neoplasias Pancreáticas/cirurgia , Idoso , Artérias , Artéria Celíaca/diagnóstico por imagem , Circulação Colateral , Artéria Hepática/patologia , Humanos , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Radiografia , Estômago/irrigação sanguíneaRESUMO
PURPOSE: To evaluate the results of combined-modality therapy, including external beam radiotherapy, intraluminal (192)Ir, and biliary stenting for extrahepatic bile duct carcinoma. MATERIALS AND METHODS: Between 1988 and 1998, 93 patients with unresectable extrahepatic bile duct carcinoma underwent definitive radiotherapy. The dose of external beam radiotherapy was 50 Gy in 25 fractions. Low-dose-rate (192)Ir was delivered at a dose of 27-50 Gy (mean 39.2) at 0.5 cm from the source. An expandable metallic endoprosthesis was used to establish an internal bile passage. RESULTS: The median survival was 12 months, with a 1-, 3-, and 5-year actuarial survival rate of 50%, 10%, and 4%, respectively. Tumor length, hepatic invasion, and distant metastasis significantly affected survival. Ninety-six percent of patients could successfully remove external drainage catheters. The actuarial biliary patency rate for these patients at 1, 3, and 5 years was 52%, 29%, and 18%, respectively. Tumor length, tumor diameter and T stage were significantly associated with the patency rate. Mild-to-severe gastroduodenal complications were observed in 32 patients and were significantly associated with the active length of (192)Ir and linear source activity. Eight patients had treatment-related biliary fistula. CONCLUSIONS: Our combined-modality therapy provided reasonable local control and improved the quality of life of patients with extrahepatic bile duct carcinoma. Because none of the treatment characteristics had any impact on survival or biliary patency, lower dose levels and/or a localized target volume are recommended to minimize morbidity.
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Neoplasias dos Ductos Biliares/radioterapia , Ductos Biliares Extra-Hepáticos , Braquiterapia/métodos , Radioisótopos de Irídio/uso terapêutico , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias dos Ductos Biliares/mortalidade , Neoplasias dos Ductos Biliares/terapia , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Radioterapia/efeitos adversos , Radioterapia/métodos , Dosagem Radioterapêutica , Estatística como Assunto , Taxa de SobrevidaRESUMO
PURPOSE: Percutaneous transhepatic portal vein (PV) embolization (PTPE) is a useful preoperative procedure for extended liver resection. The purpose of the present study was to assess the frequency of technical complications of PTPE and to discuss the risks of this procedure. MATERIALS AND METHODS: PTPE was performed in 46 patients. Forty-seven procedures were performed because an initial puncture failure required that the procedure be performed twice in one patient. The technical success rate and technical complications were assessed. Complications were analyzed with regard to approach methods and puncture sites. Approach methods were categorized as contralateral or ipsilateral. Puncture sites were categorized into anterior, posterior, and lateral segments. The results were compared statistically with use of the Fisher exact test. RESULTS: Technical success was achieved in 45 of 47 procedures (95.7%). Complications occurred in seven of 47 procedures (14.9%), including pneumothorax in two, subcapsular hematoma in two, arterial puncture in one, pseudoaneurysm in one, hemobilia in one, and PV thrombosis in one. Subcapsular hematoma and pseudoaneurysm occurred in the same procedure. No patient died as a result of complications. There was no significant difference between the contralateral and ipsilateral approaches. The incidence of complications was significantly higher in procedures involving puncture of the posterior segment than in those involving puncture of the anterior segment (P =.0374). CONCLUSION: In cases in which the anterior segment cannot be visualized for puncture, PTPE via the lateral segment or transileocolic portal embolization should be considered rather than PTPE via the posterior segment.
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Neoplasias dos Ductos Biliares/terapia , Ductos Biliares Intra-Hepáticos , Embolização Terapêutica/efeitos adversos , Neoplasias Hepáticas/terapia , Veia Porta , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/terapia , Colangiocarcinoma/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Estudos RetrospectivosRESUMO
We present a case of spontaneous rupture of hepatocellular carcinoma (HCC) with poor liver function which was treated by transcatheter arterial embolization (TAE). The patient's bilirubin value was 3.8 mg/dL. The tumor was fed by the right renal capsular artery according to selective arteriography. It was subsequently treated by TAE. With successful TAE, no hepatic failure was related to the treatment. We believe that if tumors are fed only by extrahepatic collateral vessels, TAE may be an effective treatment even in patients with poor liver function.